BACKGROUND: The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride reduces the prevalence of prostate cancer by 24.8% (risk reduction) but questions remain regarding the cost-effectiveness of widespread utilization. The purpose of the current analysis was to evaluate the cost-effectiveness of chemoprevention utilizing a quality-of-life adjustment. METHODS: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate health-related costs, beginning at age 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the PCPT; Surveillance, Epidemiology, and End-Results program; literature review of costs, utilities, and transition rates among various prostate cancer health states; and local institutional cost data. RESULTS: The quality-adjusted cost-effectiveness ratio for finasteride compared with men not receiving chemoprevention was $122,747 (in U.S.$) per quality-adjusted life-years saved (QALYs). If finasteride is assumed to not increase the incidence of high-grade tumors, the quality-adjusted cost-effectiveness ratio was $112,062 per QALYs. Sensitivity analysis found that chemoprevention of prostate cancer with an agent that has no effect on the prevalence of benign prostatic hyperplasia can render a cost-effectiveness ratio of <$50,000 per QALYs saved when applied to a high-risk population associated with a 25% risk reduction, and a cost of $30 per month. CONCLUSIONS: Finasteride is unlikely to be cost-effective when considering the impact on survival differences among treated versus untreated groups. However, chemoprevention may be cost-effective in high-risk populations when taking into consideration adjustments for the impact on quality of life.
BACKGROUND: The Prostate Cancer Prevention Trial (PCPT) demonstrated that finasteride reduces the prevalence of prostate cancer by 24.8% (risk reduction) but questions remain regarding the cost-effectiveness of widespread utilization. The purpose of the current analysis was to evaluate the cost-effectiveness of chemoprevention utilizing a quality-of-life adjustment. METHODS: A Markov decision analysis model with probabilistic sensitivity analysis was designed to determine the lifetime prostate health-related costs, beginning at age 50 years, for men treated with finasteride compared with placebo. Model assumptions were based on data from the PCPT; Surveillance, Epidemiology, and End-Results program; literature review of costs, utilities, and transition rates among various prostate cancer health states; and local institutional cost data. RESULTS: The quality-adjusted cost-effectiveness ratio for finasteride compared with men not receiving chemoprevention was $122,747 (in U.S.$) per quality-adjusted life-years saved (QALYs). If finasteride is assumed to not increase the incidence of high-grade tumors, the quality-adjusted cost-effectiveness ratio was $112,062 per QALYs. Sensitivity analysis found that chemoprevention of prostate cancer with an agent that has no effect on the prevalence of benign prostatic hyperplasia can render a cost-effectiveness ratio of <$50,000 per QALYs saved when applied to a high-risk population associated with a 25% risk reduction, and a cost of $30 per month. CONCLUSIONS:Finasteride is unlikely to be cost-effective when considering the impact on survival differences among treated versus untreated groups. However, chemoprevention may be cost-effective in high-risk populations when taking into consideration adjustments for the impact on quality of life.
Authors: Jielin Sun; A Karim Kader; Fang-Chi Hsu; Seong-Tae Kim; Yi Zhu; Aubrey R Turner; Tao Jin; Zheng Zhang; Jan Adolfsson; Fredrik Wiklund; S Lilly Zheng; William B Isaacs; Henrik Grönberg; Jianfeng Xu Journal: Prostate Date: 2010-09-28 Impact factor: 4.104
Authors: Shelby D Reed; Charles D Scales; Suzanne B Stewart; Jielin Sun; Judd W Moul; Kevin A Schulman; Jianfeng Xu Journal: J Urol Date: 2011-01-15 Impact factor: 7.450
Authors: Anna C Jones; Kristina A Trujillo; Genevieve K Phillips; Trisha M Fleet; Jaclyn K Murton; Virginia Severns; Satyan K Shah; Michael S Davis; Anthony Y Smith; Jeffrey K Griffith; Edgar G Fischer; Marco Bisoffi Journal: Prostate Date: 2011-11-29 Impact factor: 4.104
Authors: Jennifer Ku; Murray Krahn; John Trachtenberg; Michael Nesbitt; Robin Kalnin; Gina Lockwood; Shabbir M H Alibhai Journal: Can Urol Assoc J Date: 2009-12 Impact factor: 1.862